ABSTRACT
Objective: To determine the frequency of asymptomatic [silent] peptic ulcer disease [PUD] perforation and risk factors associated with it
Study design: Descriptive case series
Place and Duration of study: Surgical Unit 1, Ward-3 Jinnah Postgraduate Medical Centre [JPMC] Karachi, from January 2014 to December 2016
Methodology: All patients above twelve year of age operated due to peptic ulcer perforation with history of known case of PUD and asymptomatic patients with spontaneous perforation were included. Risk factors like H-pylori infection, use of NSAIDs, smoking, alcohol consumption, betel nut consumption and socioeconomic status were noted. Frequencies of asymptomatic and symptomatic PUD patients with perforations were determined and risk factors for both the groups were analyzed
Results: Total of 198 patients of acute peritonitis due to peptic ulcer perforation were operated in three year period. Among these 171 [86.34%] patients were male and 27 [13.64%] female. One hundred and fifty three [77.27%] patients had no previous history of PUD and 45 [22.73%] were known cases of PUD and partially treated. H-pylori was detected in 35/45 [77.77%] in symptomatic group and 115/153 [75.16%] in asymptomatic group. Smokers were 9/45[20%] in symptomatic group and 54/153 [35.29%] in asymptomatic group. NSAID and steroid users were 9/45 [20%] in symptomatic and 54/153 [35.29%] in asymptomatic group. Alcoholics were 18/45 [40%] in symptomatic and 27/153 [17.64%] in asymptomatic group. Betel nut was rare risk factor. All patients belonged to low socioeconomic group
Conclusions: Frequency of silent perforation was 77.27%. Major risk factors were H-pylori infection and NSAID use. Screening for H-pylori and use of antiulcer drugs can decrease the perforation of PUD